V4-01: Patient specific rehearsal using 3D printing for complex partial nephrectomy cases
The benefits of surgical simulation have been previously demonstrated to enhance technical skills with a downstream effect of improved patient outcomes. However, other methods to utilize simulation technology remain under-explored. One area of simulation that has proven to be difficult is the creation of a high fidelity process that accurately and reproducibly simulates individual anatomy and pathology (i.e. patient specific simulators). Advances in 3-D printing and polymer technology, coupled with software that incorporates imaging data into a computer design, make it possible to develop individualized models from patient imaging data. We present the feasibility of patient-specific preoperative rehearsal using 3D processing & printing in complex partial nephrectomy cases.
Three patients with enhancing renal lesions suspicious for renal malignancy with complex tumor morphology or significant comorbidities were chosen for preoperative simulation and rehearsal. DICOM files of patients C.T. angiography (CTA) were imported into 3D processing software to create virtual models of kidney parenchyma incorporating the tumor, renal vasculature, and pelvicalyceal system. Surgical phantoms were created using 3D printing and polymer hydrogels, for patient-specific surgical rehearsal. For whole task preoperative surgical rehearsal, other relevant anatomical elements (bowel, perinephric fat, solid organs and bony structures) were incorporated into a replicated hemiabdomen. _x000D_
All 3 preoperative simulations were completed prior to the live case. Partial nephrectomy was successful in all 3 cases with an average blood loss of 300cc and WIT of 20 minutes. For the first case, preoperative 3D processing and hydrogel kidney aided in assessing the depth of resection of a completely endophytic tumor and predicted violation of the pelvicalyceal system in the live case. In the 2nd case, the preoperative rehearsals ascertained the feasibility of completing partial nephrectomy in a 9 cm upper pole mass. In the final case, the preoperative rehearsals confirmed the feeding vessel and viability of selective ischemia with his existing coagulopathy and nephropathy. _x000D_
This initial trial demonstrates that patient-specific procedural rehearsal is effective for enhancing the performance of surgeons during a complex minimal invasive procedure. This transition from generalized to patient-specific simulation may have the potential to impact patient outcomes by permitting preoperative rehearsal. _x000D_